37  M 

H Z4m 


A Survey  of  the  Schools  by  Teachers 


No.  1 


MINIMUM  HEALTH 
AND  SANITATION  STANDARDS 
IN  SCHOOLS 


By 

LOUIS  I.  HARRIS,  M.  D.,  Dr.  P.  H. 

Director,  Bureau  of  Preventable  Diseases 
Department  of  Health 
City  of  New  York 

WKEfisnr  w uofeay 


* m 


1922 


An  Address  delivered  before  The  Teachers  Union 
of  the  City  of  New  York 


PUBLISHED  BY 

THE  TEACHERS  UNION  OF  THE  CITY  OF  NEW  YORK 
Local  5,  American  Federation  of  Teachers 

70  Fifth  Avenue,  New  York 


Price  10  Cents 


INTRODUCTION 

IN  the  month  of  January,  1921,  the  Teachers  Union  of  the  City  of  New  York  began 
a survey  of  the  public  elementary  and  high  schools  of  the  municipality.  An  appli- 
cation to  the  Board  of  Superintendents  for  a leave  of  absence  without  pay  for  the 
President  of  the  Union  has  been  made  as  a preliminary  to  undertaking  the  survey.  But 
the  application  was  refused  on  the  stated  grounds  that  there  was  no  need  of  a survey 
of  the  schools  and  that  the  person  applying  for  the  leave  of  absence  was  not  qualified 
to  undertake  a survey. 

Inasmuch  as  the  union  movement  among  teachers  is  characterized  by  a growing 
desire  on  the  part  of  teachers  to  improve  the  conditions  under  which  the  work  of 
teaching  is  carried  on,  the  Teachers  Union  decided  to  go  ahead  with  its  plans. 
Accordingly,  it  was  decided  by  the  Union  that  the  President  should  resign  his  position 
as  teacher  in  a high  school.  The  resignation  was  accepted  January  3,  1921. 

The  letter  of  resignation  dated  December  14,  1920,  contains  this  statement  quoted 
here  to  indicate  the  scope  of  the  inquiry  proposed:  “Among  the  conditions  inquired 
into  should  be  the  following:  The  physical  conditions,  the  conditions  relative  to  ad-  1 
ministration,  the  conditions  relating  to  teaching.  In  addition,  I believe  it  is  important  ' 
that  studies  be  made  of  the  quality  of  our  ideals  in  relation  to  the  prevailing  schools 
of  educational  thought.  In  this  connection,  we  should  know  the  source  of  the  moral, 
the  social,  the  civic  and  the  professional  inspiration  of  our  teachers.  The  study  of  } 
these  conditions  in  relation  to  the  product  as  shown  in  the  output  of  our  schools  and  in 
the  quality  of  our  citizenship  should  give  us  important  leads  for  fundamental  changes/’ 
Those  who  are  familiar  with  conditions  in  the  field  of  public  education  know  that 
the  teachers  themselves  have  developed  few  standards  of  a professional  nature.  What- 
ever standards  there  are  have  been  set  up  by  those  who  control.  They  are  modified 
scarcely  at  all  by  those  who  do  the  work  of  teaching.  In  general  this  state  of  affairs 
has  tended  to  establish  among  teachers  a feeling  of  indifference  to  conditions  of  work. 
In  the  City  of  New  York  many  teachers  seem  to  believe  that  certain  unfavorable  con- 
ditions under  which  they  endeavor  to  do  their  work  are  unavoidable,  and  make  no 
effort  to  have  them  corrected.  Doubtless  a large  number  of  teachers  do  not  even 
desire  better  conditions,  because  of  ignorance  of  higher  standards  than  now  prevail. 

The  Teachers  Union  since  its  organization  in  March,  1916,  has  been  associated 
with  the  union  movement  in  industry,  and  has  become  convinced  that  the  development 
of  standards  in  education  must  take  a path  similar  to  that  followed  by  the  workers. 
If  conditions  are  to  be  improved,  the  effort  in  that  direction  must  be  made  by  the 
persons  who  are  in  direct  contact  with  the  conditions.  Democracy  in  education,  as  in 
industry,  cannot  exist  without  the  organized  and  democratically  controlled  effort  of 
the  workers. 

Improvement  in  the  conditions  under  which  work  is  done  leads  logically  to  im- 
provement in  the  product  of  work.  The  Teachers  Union  has  striven  to  make  clear 
to  the  teachers  the  need  of  professional  standards  that  will  aid  all  those  who  teach  in 
producing  work  that  has  marks  of  high  educational  and  social  value.  The  Union 
believes  that  the  first  step  in  the  direction  of  educating  the  members  of  our  profession 
to  think  in  terms  of  standards  is  to  set  before  teachers  such  health  and  sanitation 
standards  as  those  offered  in  this  publication.  The  author  of  the  article  printed  here- 
with was  for  several  years  Director  of  the  Division  of  Industrial  Hygiene  of  the  New 
York  City  Department  of  Health.  In  that  position,  and  as  teacher  of  Industrial 
Hygiene  in  Bellevue  Medical  School,  as  well  as  in  his  present  position  in  the  Depart- 
ment of  Health,  Dr.  Harris  has  been  able  to  speak  with  authority  on  the  subject  of  * 
standards  of  health.  # * 

The  distribution  of  this  pamphlet  among  the  members  of  the  Teachers  Union  will 
be  followed  by  a study  of  the  physical  conditions  prevailing  in  the  schools  covered  by , 
our  membership.  The  facts  thus  collected  will  be  prepared  as  a publication  of  this  ^ 
School  Survey  series,  and  will  be  used  for  the  purpose  of  arousing  the  public  to  the 
realization  of  the  actual  physical  environment  in  which  children  spend  their  days  in 
school.  A serious  effort  will  be  made  to  carry  out  a study  of  the  health  of  teachers 
along  the  lines  suggested  by  Dr.  Harris.  Preliminary  inquiries  made  of  our  members 
indicate  that  it  will  be  possible  to  obtain  the  consent  of  at  least  one  thousand  teachers 
to  agree  to  having  exact  studies  made  of  their  personal  health  in  relation  to  their 
work  as  teachers. 

The  Teachers  Union  expects  that  the  establishment  of  improved  standards  of  a 
physical  nature  in  the  schools  will  not  be  attained  until  the  teachers  themselves  have 
increased  their  interest  in  the  matter  of  needed  changes.  Similarly,  in  the  administra- 
tion and  in  the  teaching  standards,  which  have  already  been  given  some  attention  by 
our  organization,  hard  work  and  constant  agitation  will  be  necessary  to  the  attain- 
ment of  our  aims. 

This  pamphlet  is  offered  to  the  public  as  a social  contribution  by  teachers  to  the 
work  of  preparing  children  for  life.  Other  contributions  made  with  the  same  end  in 
view  will  follow  as  rapidly  as  means  and  time  make  possible. 

The  Teachers  Union  of  the  City  of  New  York. 

HENRY  R.  LINVILLE,  President 


MINIMUM  HEALTH  AND  SANITATION  STANDARDS  IN  SCHOOLS* 

LOUIS  I.  HARRIS,  M.D.,  Dr.  P.  H. 

Director,  Bureau  of  Preventable  Diseases,  Department  of  Health, 

City  of  New  York 

IN  this  address  it  is  aimed  to  present  an  outline  of  minimum  sanitation  standards 
for  the  protection  of  school  children  and  teachers.  The  contributions  made 
by  various  observers  to  our  knowledge  of  the  sanitary  and  working  condi  - 

(tions  in  schools  and  their  effects  upon  the  health  of  the  pupils  and  teachers 
are  very  meagre.  Much  valuable  information  is  available  with  reference  to  the 
health  of  school  children  as  a result  of  school  medical  examinations  and  special 
studies.  Aside  from  Terman’s  ‘The  Teacher’s  Health,”  there  have  been  no  very 
substantial,  scientific  or  comprehensive  contributions  on  the  subject  of  the  health  of 
teachers.  The  health  of  the  teacher  determines  not  only  the  quality  of  his  services 
to  the  individual  and  to  the  community  as  a whole,  but  is  also  of  grave  concern  to 
every  parent  as  an  index  of  sanitary  conditions  in  the  school  environment. 

A note  of  caution  should  be  sounded  with  respect  to  certain  fallacies  that 
ers,  particularly  those  dealing  with  the  mortality  rate  from  various  diseases  among 
underlie  the  statistical  studies  which  have  been  made  of  the  health  of  school  teach- 
those  so  employed  as  contrasted  with  other  occupational  groups.  The  reports  of 
the  Schlockow  Committee  and  of  Dr.  L.  I.  Dublin  on  this  subject  do  not  present 
typical  cross-sections  which  give  a fair  basis  for  judgment  as  to  the  degree  to 
which  the  teaching  profession  is  a hazardous  one.  These  studies  present  but  a 
fragmentary  picture  covering  a limited  period  of  time,  and  in  the  main,  a record 
of  those  illnesses  and  diseases  exclusively,  for  which  the  regulations  provide  com- 
pensation or,  which,  for  other  special  reasons,  come  under  official  notice. 

Those  who  venture  to  offer  definite  conclusions  with  reference  to  the  presence 
or  absence  of  hazards  in  the  school  environment  and  the  number  and  causes  of 
illness  and  deaths  are  prone  to  make  the  same  serious  error  that  frequently  is 
noted  with  respect  to  military  statistics.  The  cases  of  illness  and  of  disease  which 
are  published  in  military  statistics  are,  by  and  large,  those  which  cause  a relatively 
marked  disability.  At  the  close  of  the  recent  war,  morbidity  and  mortality  statis- 

Itics  were  published  showing  the  incidence  of  disease  and  of  deaths,  and  their 
causes,  in  the  army.  Since  then,  however,  through  various  sources — official  and 
unofficial — much  additional  information  has  come  to  light  about  the  many  cases 
of  so-called  “irritable  heart,”  of  mental  disease,  as  well  as  of  thousands  who  since 
the  close  of  the  war  have  come  to  official  notice  as  the  subjects  of  tuberculosis, 
or  as  suffering  from  the  sequelae  of  poison  gases,  under-nutrition,  severe  physical 
labor,  and  exposure.  These  as  well  as  other  conditions  have  been  responsible  for 
much  illness  or  disability  which  did  not  appear  in  official  records.  Those  who 
continued  in  the  trenches  despite  certain  more  or  less  significant  illness  were  also 
never  reported.  Likewise,  with  respect  to  the  statistical  studies  of  teachers. 

The  Kind  of  Study  That  is  Needed 

What  is  now  required  is  a study  that  will  reveal  not  only  the  cases  of  illness 
in  teachers  which  come  to  official  notice,  but  also  a large  number  not  officially 

* Address  delivered  before  The  Teachers  Union,  March  17,  1921. 

o 


4 


Survey  of  the  Schools  by  Teachers 


noticed,  which  have  a serious  effect  upon  the  physical  and  mental  well-being 
of  teachers,  affecting  their  capacity  to  teach  and  the  quality  of  their  work.  We 
should  know  how  many  of  these  teachers  persist  in  remaining  on  active  duty 
in  the  trenches,  so  to  speak,  despite  ailments  and  illnesses  which  affect  them,  and 
who  thus  really  “malinger”  or  pretend  to  the  possession  of  health  which  they  do  not 
have.  Such  studies  should  cover  an  adequate  span  of  years  and  should  subdivide 
the  teachers  who  form  the  subject  of  such  studies,  not  only  according  to  sex,  but 
into  the  various  age-groups,  so  that  we  may  record  whether  they  are  subject  to  a 
variety  of  diseases  which  are  directly  or  indirectly  caused  by  their  vocation,  and 
particularly  whether  such  diseases  appear  in  a relatively  early  age  or  group.  In 
other  words,  whether  they  suffer  prematurely  from  the  effects  of  fatigue,  from 
any  specific  disease,  or  from  the  result  of  exposure  to  unsanitary  conditions.  The 
cases  of  illness  should  be  studied  and  referred  back,  if  possible,  so  as  to  learn  1 
whether  there  is  an  association  between  a particular  type  of  illness  or  disease  or 
cause  of  death,  and  the  conditions  obtaining  in  respective  schools. 

Such  studies  should  aim  to  determine  how  much  of  the  “labor  turnover”  or  the 
desertions  from  the  ranks  of  the  profession  are  due  to  discomfort  or  ill  health 
induced  by  the  nature  of  the  work.  As  the  result  of  their  experience,  industrial 
hygienists  invariably  ascribe  a certain  amount  of  labor  turnover  to  conditions  in 
industry  which  have  a relation  to  health  and  comfort.  In  such  studies,  emphasis 
should  not  be  laid  merely  upon  the  number  of  deaths,  or  even  upon  the  number  of 
cases  of  illness  from  various  causes,  but  special  consideration  should  be  given  to  the 
question  whether  the  work  in  a given  group  or  type  of  teachers  is  compatible  with 
“keeping  fit”  so  as  to  enable  the  teachers  to  enjoy  normal  and  healthful  life.  Fur- 
thermore, such  studies  should  not  be  rated  as  complete  unless  they  are  based  on  the 
most  careful  clinical  observation  of  a large  number  of  teachers  over  a considerable 
period  of  time,  so  as  to  measure  more  accurately  the  effect  of  the  work  that  they  are 
doing  upon  the  general  powers  of  resistance  and  general  well-being,  as  well  as  upon 
the  nervous  system,  the  heart,  the  digestive  system,  the  lungs,  and  the  other  parts 
of  the  body.  Due  consideration  should  of  course  be  given  to  any  personal  habits, 
unusual  home  conditions,  or  to  a physical  condition  antecedent  to  entering  the  pro- 
fession, which  may  have  exerted  an  influence  in  causing  certain  clinical  conditions 
that  may  be  observed  in  the  course  of  such  studies. 

In  the  slow  evolution  of  things,  the  necessity  for  the  medical  examination  and 
supervision  of  school  children  has  become  recognized  by  civilized  nations  and  by 
the  more  progressive  communities.  We  must  be  sure  that  school  children  who  are 
being  medically  examined  for  the  discovery  and  correction  of  physical  defects  are 
not  in  the  meanwhile  subject  to  environmental  conditions  within  the  school  which 
may  in  greater  or  less  measure  be  responsible  for  the  development  of  such  physical 
defects  and  disease.  Therefore,  the  sanitary  conditions  of  the  school  environ- 
ment and  the  health  of  the  school  teacher  who  comes  in  immediate  contact  with 
school  children  are  interlocked,  and  must  be  most  carefully  considered  together. 

The  school  teacher  who  suffers  from  a communicable  disease,  such  as  pul- 
monary tuberculosis,  is  a grave  menace  because  of  the  intimate  contact  with  rela- 
tively large  numbers  of  children,  who,  as  medical  men  well  know,  are  most  subject 
to  tuberculous  infection.  Therefore,  the  sanitary  conditions  prevailing  in  schools 
which  may  favor  the  development  of  tuberculosis  or  other  communicable  dis- 
eases are  of  very  great  significance  from  the  standpoint  of  their  influence  upon 


Minimum  Health  and  Sanitation  Standards 


5 


pupil  and  teacher.  Moreover,  ill  health  may  have  a very  serious  effect  upon  the 
disposition  and  temperament  of  school  teachers,  and  may  seriously  influence  their 
work  in  molding  the  character  of  the  pupils  under  their  care. 

Fatigue 

With  our  gradual  advance  in  medical  knowledge  has  come  a better  understand- 
ing of  the  particular  significance  of  fatigue,  not  only  as  the  cause  of  mental 
strain,  of  so-called  “neurasthenia,”  but  also  as  the  cause  of  a direct  or  indirect 
reaction  through  nervous  channels  upon  various  organs  and  glands  in  the  body, 

I the  complex  actions  of  which  are  delicately  balanced  and  correlated.  A disturbance 
of  one  such  organ  or  gland  may  radiate  to  many  others,  and  cause  perversions  of 
circulation,  and  of  many  of  the  vital  processes  of  life.  We  have  also  come  to 
appreciate  the  fact  that  the  powers  of  resistance  of  the  body,  which  determine 
how  susceptible  an  individual  may  be  to  any  one  of  the  communicable  diseases, 
are  very  seriously  affected  and  undermined  by  fatigue.  Fatigue,  therefore,  aside 
from  causing  certain  nervous  or  mental  disorders  may  play  a serious  role  in 
influencing  the  development  of  a variety  of  organic  diseases,  or  in  predisposing 
individuals  to  communicable  diseases. 

Fatigue  is  not  only  determined  by  the  number  of  hours  of  work,  or  by  the 
number  of  days  of  work  each  week,  but  depends  to  a great  degree  upon  the  char- 
acter of  such  work.  It  is  especially  induced  by  the  necessity  of  concentrating, 
and  taxing  the  attention,  the  memory,  and  general  alertness.  For  example,  every- 
one who  has  had  experience  in  studying  fatigue  in  industry  has  given  attention 
to  the  strain  upon  the  girls  engaged  in  the  process  of  weaving  who  may  have  to 
take  care  of  twelve  or  even  more  looms  at  a time,  or  upon  girls  doing  similar 
types  of  work  which  require  them  to  attend  to  from  twelve  to  thirty  or  forty  units 
of  machinery  at  one  time.  In  like  fashion  each  pupil  may  justly  be  regarded  as 
comparable  to  a unit  of  machinery,  insofar  as  it  taxes  and  strains  the  mental  and 
visual  faculties  of  the  teacher,  and  causes  a physical  effort  on  the  part  of  the 
teacher  in  the  course  of  teaching,  disciplining  and  speaking  to  a large  group.  No 
one,  except  those  who  have  done  public  speaking  or  teaching  continuously  for  pro- 
longed periods,  can  appreciate  the  physical  as  well  as  the  mental  strain  which  con- 
stant loud  speaking  may  cause.  Fatigue  is  greatly  aggravated  by  any  insanitary 

I condition  which  may  obtain  in  the  school  or  classroom.  Excessive  heat,  poor 
ventilation,  inadequate  lighting,  dust  in  the  air — all  of  these,  and  many  other 
environmental  factors  tend  to  aggravate  as  well  as  to  induce  fatigue. 

In  industry  it  has  frequently  been  possible  for  experts  who  study  fatigue,  to 
recognize  its  presence  and  to  estimate  its  degree  by  the  amount  of  spoiled  work 
which  is  produced  by  those  who  are  suffering  from  this  condition.  Unfortunately, 
this  test  cannot  be  applied  in  dealing  with  that  intangible  product  of  the  teachers’ 
labors — namely,  knowledge  and  character  development.  It  would  be  of  inestim- 
able value  if  the  “spoiled  work”  of  teachers,  as  the  result  of  the  fatigue  from 
which  they  may  be  suffering,  could  be  even  approximately  estimated.  It  would 
be  most  valuable  to  know  how  many  children  were  unfavorably  influenced  with 
respect  to  the  acquirements  of  character  and  knowledge,  or  were  “spoiled”  or 
marred  in  the  process  of  their  making  as  the  result  of  fatigue  in  the  teacher.  Un- 
fortunately, it  has  been  found  that  workers  themselves  are  not  always  conscious 
of  fatigue,  nor  are  their  sensations  a reliable  guide  as  to  its  presence.  For  these 


6 


Survey  of  the  Schools  by  Teachers 


reasons  too  much  stress  cannot  be  laid  upon  the  importance  of  having  proper  and 
sanitary  environment,  so  that  children  who  spend  a considerable  part  of  their 
growing  years  in  the  school  environment  shall  not  be  unfavorably  affected  by 
insanitary  conditions — and  teachers  likewise — and  so  that  conditions  of  work  shall 
not  be  productive  of  fatigue  which  may  cause  a marked  susceptibility  to  dis- 
ease in  both  pupil  and  teacher,  or  be  reflected  ultimately  in  the  character  of  the 
children  who  come  out  of  our  schools. 

Occupational  Diseases  of  Teachers 

While  tuberculosis  is  not  a conspicuous  hazard  in  the  teaching  profession,  it 
must  nevertheless  be  reckoned  with  as  a most  important  disease,  to  which  teachers 
are  in  a fair  measure  exposed  and  subject.  No  adequate  scientific  work  has  yet 
been  done  under  proper  medical  direction  to  ascertain  to  what  extent  the  physical 
condition  of  teachers  before  they  enter  upon  their  profession,  or  the  home  con- 
ditions, the  school  environment,  or  the  exposure  to  conditions  which  may  favor 
the  development  of  bronchitis  or  respiratory  infections,  as  well  as  personal  habits, 
may  each  contribute  to  call  into  activity  a latent  tuberculous  infection  which  most 
adults  harbor,  and  cause  an  active  process  to  be  lighted  up.  In  the  study  made 
by  Dublin  of  morbidity  and  mortality  statistics  which  were  available  through 
official  sources,  he  pointed  out  that  only  thirty-eight  teachers  had  pulmonary 
tuberculosis  during  1915.  It  is  reasonable  to  suppose  that  the  thorough  and  sys- 
tematic physical  examination  of  our  school  teachers  would  have  revealed  a very 
considerable  amount  of  tuberculosis  that  had  not  previously  been  recognized  or 
disclosed.  Pulmonary  tuberculosis,  even  if  there  be  but  thirty-eight  cases  of  it 
among  school  teachers,  is  a much  more  grave  condition  in  members  of  this  pro- 
fession who  come  in  such  direct  and  intimate  contact  with  great  masses  of  children 
than  is  indicated  by  its  numerical  prevalence.  Especially  because,  as  already  men- 
tioned, childhood  is  the  age  of  greatest  susceptibility  to  tuberculosis,  the  tuber- 
culous teacher  is  potentially  a distributor  of  such  infection  to  all  of  his  or  her 
pupils. 

Other  Occupational  Diseases 

While  there  is  much  that  is  indefinite  with  reference  to  the  prevalence  of 
specific  occupational  hazards  or  diseases  among  teachers,  because  of  the  fallacious 
methods  of  inquiry  upon  which  we  have  heretofore  had  to  depend  for  our  statis- 
tical knowledge,  one  may,  however,  state  quite  definitely  on  the  basis  of  statistical 
evidence  that  tuberculosis,  chronic  laryngitis,  or  “speaker’s  voice,”  nervous  dis- 
orders which  assume  a variety  of  forms,  especially  so-called  “neurasthenia,”  diges- 
tive disorders,  respiratory  infections  (notably  acute  bronchitis,  influenza,  pneu- 
monia and  follicular  tonsilitis),  as  well  as  defective  eyesight,  may  be  properly 
regarded  as  occupational  diseases  incident  to  teaching. 

Neurasthenia  and  other  nervous  disorders  have  already  been  referred  to  as 
being  very  frequent  among  school  teachers ; — it  is  fair  to  assume  this  prevalence, 
not  only  on  a statistical  basis  but  also  because  they  have  been  found  to  be  most 
markedly  prevalent  among  skilled  workers  in  various  other  professions  and  trades. 
As  already  briefly  indicated,  the  nervous  manifestations  may  cause  reflex  dis- 
turbances as  of  the  digestive  organs,  or  the  generative  organs  in  females.  Such 
nervous  disorders  may  be  temporary  in  character,  or  they  may  be  firmly  and  per- 


Minimum  Health  and  Sanitation  Standards 


7 


manently  established.  Acute  infectious  diseases  would  no  doubt  be  found  to  be 
relatively  frequent,  if  the  health  of  teachers  was  studied,  not  merely  by  means  of 
the  compilation  of  inadequate  statistics,  but  by  continuous  medical  supervision, 
and  by  follow-up  to  ascertain  the  causes  of  absence.  The  intimate  contact  of 
teachers  with  children,  who,  as  is  Well  known,  are  especially  susceptible  to  a 
variety  of  acute  infectious  diseases,  makes  them  likely  to  contract  such  diseases. 

Chronic  laryngitis  has  been  very  frequently  found  among  teachers,  as  indeed 
among  others  who  are  compelled  to  use  their  voice  a good  deal.  This  results  in 
hoarseness  and  very  considerable  discomfort,  and  may  be  followed  by  a secondary 

(bronchitis,  resulting  from  extension  of  the  inflammatory  conditions  affecting  the 
larynx  and  the  pharynx.  Laryngitis,  and  acute  or  chronic  bronchitis,  are  in  a 
measure  capable  of  being  caused  as  the  result  of  exposure  to  chalk  dust.  Dr. 
George  M.  Kober  in  his  latest  work  (Kober  & Hanson’s  Occupational  Diseases) 
has  particularly  emphasized  the  hazard  from  chalk  dust  not  only  with  relation  to 
bronchitis,  but  with  reference  to  the  development  of  pulmonary  tuberculosis.  In 
reviewing  the  prevalence  of  tuberculosis  in  teachers  which  some  writers  have 
reported  as  being  comparatively  low,  he  says : “Higher  rates  for  tuberculosis  have 
been  reported  by  Schmidt  of  Dusseldorf  (than  death  rate  of  1.3  males  and  1.55 
per  1000  females  in  Bavaria),  and  our  American  statistics  also  indicate  that  school 
teachers  are  slightly  more  liable  to  tuberculosis  than  members  of  the  other  learn sd 
professions. 

“This  is  doubtless  due  to  indoor  life,  confinement  in  badly  ventilated  school 
rooms  and  the  presence  of  dust.  Diseases  of  the  nervous  system  and  uterine 
organs  are  also  quite  common,  and  teachers  will  do  well  to  insist  upon  proper 
seats,  absolute  cleanliness  of  the  school  room,  fresh  air  schools,  or  at  least  copious 
ventilation,  and  susbstitution  of  wet  for  dry  methods  of  removing  chalk  mark- 
ings.” 

Defective  eyesight  is  very  commonly  found  among  school  teachers,  and  while 
no  doubt  it  is  in  a measure  due  to  the  strain  upon  the  eyes  in  the  course  of  prepa- 
ration for  their  profession,  it  may  also,  however,  be  produced  in  a very  consider- 
able number  of  cases  by  the  strain  to  which  sight  is  subjected  in  the  course  of 
routine  work,  and  particularly  by  defects  of  lighting.  While  there  is  insufficient 
evidence  to  warrant  many  of  the  statements  which  have  been  made  with  reference 
| to  the  prevalence  of  certain  diseases  among  teachers,  one  may  nevertheless  venture 
I to  assert  that  thorough  and  frequent  medical  examination  of  many  teachers  over 
I an  extended  period  of  time,  with  a scientific  method  of  health-bookkeeping,  would 
| show  the  existence  of  numbers  of  organic  defects  which  have  not  thus  far  been 
recognized  or  justly  appraised.  Surely,  the  glib  dismissal  of  diseases  said  to  be 
associated  with  teaching  which  has  sometimes  marked  the  reports  of  certain 
studies  based  on  manifestly  inadequate  statistical  evidence,  is  not  scientific  and 
has  tended,  unintentionally  no  doubt,  to  treat  these  moot  points  as  if  they  had 
been  settled  conclusively  and  for  all  time. 

In  marshalling  statistics  one  must  be  cautious  in  their  use  and  in  their  selec- 
tion that  they  may  not  consciously  or  otherwise  be  pressed  into  service  to  bolster 
up  fixed  preconceptions.  As  illustration  one  might  balance  against  some  statistics 
which  have  been  published  to  discount  the  existence  of  occupational  hazards  in 
the  teaching  profession,  the  report  contained  in  Bulletin  No.  106  of  the  U.  S. 
Bureau  of  Census  for  1909  in  which  it  is  shown  that  in  certain  age-periods  the 


8 


Survey  of  the  Schools  by  Teachers 


mortality  of  female  teachers  from  certain  infectious  diseases  is  higher  than  for 
the  general  mass  of  females  in  industry;  and  from  organic  heart  diseases  the 
mortality  is  higher  for  the  ages  25  to  44  years  than  among  the  general  workers 
of  the  same  age-groups;  also  the  mortality  is  higher  for  a kidney  disease  in  the 
age-group  35  to  44  years  for  female  teachers  than  it  is  for  general  workers. 

DEATHS  OF  PERSONS  IN  OCCUPATIONS 


Teachers,  Professors  in  Deaths 
Colleges  (Females)  All  Causes 


Per  Cent,  of  All  Cases  at  Specified  Ages 


TUBERCULOUS  LUNGS 


APOPLEXY  AND  PARALYSIS 


25 

to 

34 

years  . . 

...  269 

35 

<< 

44 

a 

.. . 194 

45 

it 

54 

a 

..  . 167 

55 

a 

64 

it 

...  130 

760 

Teachers 

General 

Workers 

Female 

Workers 

38.7 

31.0 

35.7 

19.1 

23.6 

21.3 

7.8 

14.4 

10.2 

7.7 

7.5 

5.6 

ichers  General  Female 
Workers  Workers 

1.5  1.2  1.3 

4.1  2.7  4.0 

7.8  5.9  8.4 

6.9  10.1  12.3 


HEART  DISEASE  PNEUMONIA  BRIGHT’S  DISEASE 

(All  Forms) 


Teachers 

General 

Workers 

Female 

Workers 

Teachers 

General 

Workers 

Female 

Workers 

Teachers 

General 

Workers 

Female 

Workers 

25  to  34 

years  . . 

. . 5.2 

4.8 

6.4 

5.2 

7.4 

5.7 

2.6 

4.0 

4.6 

35  “ 44 

a 

. . 9.3 

7.7 

10.5 

11.9 

9.5 

6.4 

7.2 

6.6 

7.7 

45  “ 54 

a 

. . 8.4 

11.3 

12.7 

7.2 

9.0 

8.0 

9.0 

9.7 

10.0 

55  “ 64 

a 

. . 10.0 

15.4 

15.4 

11.5 

8.3 

9.0 

10.0 

11.7 

11.5 

These  tables,  although  significant,  show  how  inadequate  available  statis- 
tics are. 

Ventilation 


It  may  be  stated  without  fear  of  contradiction  that  ventilation  is  the  most 
important  factor  in  relation  to  the  health  of  workers.  Defects  of  ventilation  are 
the  most  important  single  cause  of  disease  in  industry.  A statement  of  all  that 
the  term  “ventilation”  comprises  when  it  is  used  by  an  industrial  hygienist  will 
make  clear  why  it  is  of  great  significance.  This  holds  equally  true  with  reference 
to  the  school,  because  it  is  proper  to  consider  the  school  as  the  industrial  estab- 
lishment in  which  are  engaged  thousands  who  are  acquiring  knowledge  and  sub- 
mitting to  character  development;  it  is  the  business  environment  in  which  a con- 
siderable fraction  of  the  lives  of  pupils  and  teachers  is  spent  each  year.  It  is 
commonly  understood  that  ventilation  implies  the  furnishing  of  an  adequate  supply 
of  fresh  air  to  a given  room,  factory,  or  other  space.  The  industrial  hygienist, 
however,  is  not  concerned  merely  that  the  air  which  is  furnished  should  be  ade- 
quate in  quantity,  but  also  endeavors  to  have  it  free  from  contamination  both 
before  and  after  it  enters  a room.  He  desires  also  that  dust,  bacteria  or  the 
exhalations  and  emanations  of  the  human  body  and  the  gases  generated  by  the 
burning  of  gaslights  be  effectively  withdrawn ; that  the  air  be  of  suitable  temper- 
ature and  humidity;  that  it  be  kept  in  motion  so  as  not  to  stagnate,  and  that  it 
should  not  be  delivered  in  such  manner  as  to  drive  it  through  a given  space  or 
room  at  a great  velocity,  thus  creating  a draft.  The  air  supplied  must  be  dis- 
tributed to  all  parts  of  the  room.  (This  is  especially  important  when  mechanical 
ventilation  is  depended  upon.)  Natural  ventilation  through  windows  or  skylights 
is  by  far  the  best.  If  ventilation  is  obtained  through  natural  means,  that  is,  by 


Minimum  Health  and  Sanitation  Standards 


9 


i 


an  adequate  supply  of  windows,  or  skylights,  it  obviously  implies  that  lighting 
will  at  the  same  time  also  be  improved.  When,  because  weather  conditions  are 
unfavorable,  or  structural  arrangements  are  old  or  defective,  or  when  for  a 
variety  of  other  reasons  it  is  inadvisable  to  depend  upon  natural  ventilation,  one 
must  re-enforce  or  replace  it  by  resort  to  artificial  methods  of  ventilation  which 
depend  upon  fans  to  propel  air  into  a room  as  well  as  to  exhaust  or  remove  con- 
taminated air.  Frequently,  artificial  ventilation  devices,  even  though  they  may 
have  been  installed  at  very  great  expense  and  at  considerable  trouble,  have  been 
found  to  be  defective  and  impracticable  in  operation.  Even  when  a mechanical 
system  of  ventilation  is  found  necessary,  it  does  not  justify  failure  to  open  win- 
dows at  all  times  when  the  weather  conditions  permit. 

The  latter  statement  is  in  direct  conflict  with  the  views  which  have  been  held 
and  enforced  with  reference  to  this  subject,  and  as  the  result  of  which  no  one 
has  been  permitted  to  open  windows  while  ventilating  devices  were  in  operation. 
Authority  for  this  new  view  is,  however,  to  be  found  in  the  special  report  made 
by  the  Divisional  Committee  on  Heating  and  Ventilation  of  the  Committee  on 
Welfare  of  the  Advisory  Commission,  Council  of  National  Defense.  This  most 
important  report  was  prepared  by  some  of  the  foremost  engineering  authorities 
in  the  country.  For  the  sake  of  emphasis  and  to  overcome  the  harmful  effects 
of  wrong  teaching  which  have  been  in  force  hitherto,  it  is  desirable  to  repeat  that 
the  installation  of  a mechanical  system  of  ventilation  in  rooms  where  the  natural 
agencies  for  ventilation  fail  or  are  found  insufficient,  does  not  justify  the  old 
theory  that  the  opening  of  windows  in  such  rooms  destroys  the  effectiveness  of 
mechanical  ventilation  when  the  latter  is  in  operation.  From  a hygienist’s  point  of 
view,  quoting  the  exact  words  of  the  report  above  referred  to,  “a  room  cannot 
possibly  have  too  many  windows,  nor  can  they  be  opened  too  often  or  too  much 
when  the  external  weather  conditions  permit.” 

The  report  of  the  Divisional  Committee  on  Heating  and  Ventilation  of  the 
Council  of  National  Defense,  which  has  already  been  referred  to  as  an  authori- 
tative guide,  unfortunately  does  not  make  adequate  provision  for  the  amount  of 
space  to  be  furnished  each  occupant  of  a working  place.  A minimum  of  400  cubic 
feet  of  air  space  per  person  should  be  insisted  upon ; 600  cubic  feet  per  person  is 
the  optimum.  While  it  is  our  business  to  urge  and  compel  children  who  cough 
or  sneeze  to  cover  up  their  mouths  and  noses  with  their  handkerchiefs,  we  must 
nevertheless  provide  an  adequate  amount  of  space  for  each  child  in  a classroom, 
so  that  it  will  be  out  of  range  of  the  discharges  from  a sneezing  or  coughing 
neighbor ; this  is  a necessary  measure  of  protection  against  contact  infection.  For 
this  purpose  a minimum  of  20  square  feet  of  floor  space  is  necessary  for  each 
child  in  a classroom.  In  apportioning  the  above  amount  of  space,  it  is  not  intended 
that  one  should  include  in  such  computation  those  areas  of  a room  which  are  not 
used  for  seating  purposes ; the  aisles,  however,  may  be  included  in  such  computa- 
tion. 


For  the  purpose  of  adequate  ventilation,  rooms  should  be  required  to  have  a 
sufficient  amount  of  window  space  so  as  to  allow  21  square  feet  of  window  area 
for  every  occupant  of  the  room ; such  windows,  however,  should  open  directly  to 
outdoors.  When  the  area  of  the  window  space  for  each  occupant  averages  less 
than  21  square  feet  in  a given  room,  it  calls  for  the  installation  of  a mechanical 
method  of  ventilation  to  supplement  natural  ventilation.  When  a mechanical 


10 


Survey  of  the  Schools  by  Teachers 


method  of  ventilation  is  necessary,  the  minimum  amount  of  air  space  should  be 
not  less  than  600  cubic  feet  of  air  per  person  per  hour.  If,  for  example,  youi 
have  a classroom  in  which  there  are  forty  children,  and  you  have  only  700  square; 
feet  of  window  area  instead  of  the  optimum  840  square  feet,  then  you  have  a 
deficiency  of  140  square  feet  of  window  area  in  such  room.  For  each  square  foot 
of  window  area  that  is  lacking  100  cubic  feet  of  air  ought  to  be  supplied  for  each 
occupant  per  hour.  In  other  words,  the  mechanical  ventilating  device  must  com- 
pensate for  the  deficiency  of  window  area  in  the  room  by  supplying  140  times  10C 
cubic  feet  of  air  for  each  of  the  40  pupils.  While  the  essentials  of  this  calcula- 
tion concern  only  the  engineer,  they  are  offered  in  this  connection  to  show  that  it 
is  not  sufficient  merely  to  have  an  elaborate  ventilating  device  in  the  room,  but 
that  the  amount  of  air  which  is  delivered  must  be  accurately  regulated.  To  be 
satisfied  merely  with  the  placing  of  a flag  in  front  of  each  ventilator  and  to  accept 
its  fluttering  as  an  indication  that  all  is  well,  as  has  been  the  custom  in  man> 
schools,  is  to  place  reliance  on  a very  poor  index  of  efficiency.  Moreover,  all 
locker  rooms  or  wardrobe  spaces  should  be  adequately  ventilated. 

In  this  connection,  it  should  be  pointed  out  that  the  ordinary  method  of  stor- 
ing clothes  is  one  which  is  not  conducive  to  safety  or  good  health,  unless  a proper 
amount  of  space  exists  between  the  clothing  of  each  individual  child,  so  that  there 
mav  be  no  point  of  contact,  and  unless  the  space  in  which  clothing  is  stored  is 
well  ventilated  and  well  lighted.  The  sterilizing  effect  of  sunlight  not  only  upor 
the  air  of  rooms  which  must  be  breathed  by  persons,  but  also  upon  the  air  oi 
locker  spaces  must  not  be  overlooked. 

The  air  must  not  be  discharged  with  velocity  at  some  point  in  a room  to  tht 
inconvenience  of  some  of  its  occupants  but  should  be  properly  distributed  through 
out  such  room.  Children  who  are  seated  near  the  windows  in  a room  when 
natural  ventilation  is  depended  upon,  should  be  guarded  by  a deflector — an  inclinec 
glass  or  wooden  shield  placed  across  the  lower  end  of  such  windows,  to  defied; 
upward  air  currents  entering  the  room  so  that  they  will  not  directly  strike  the 
children.  In  a similar  fashion  children  who  are  seated  near  radiators  or  othei 
heating  devices  may  suffer  from  the  effects  of  excessive  heat.  Such  radiators 
should  be  properly  insulated  by  non-conducting  material  (asbestos),  and  the 
heated  air  should  be  deflected  upward,  or,  better  still,  the  radiators  or  heating 
units  should  be  so  distributed  as  to  be  at  a distance  from  children’s  seats.  i 

In  a study  made  by  Dr.  S.  J.  Baker,  the  Director  of  the  Bureau  of  Chile 
Hygiene  of  the  New  York  Department  of  Health,  it  was  shown  that  in  the  j 
closed-window  room  which  was  ventilated  mechanically  and  kept  at  a temperature 
of  about  58  degrees  F.,  the  rate  of  absences  as  the  result  of  respiratory  disease 
was  32  per  cent,  greater  than  in  the  open-window  rooms  which  were  naturall) 
ventilated  and  kept  at  the  same  temperature.  The  best  condition  of  health  witl 
respect  to  the  prevalence  of  respiratory  diseases  is  found  to  obtain  in  the  open- 
window  classes.  At  comparatively  frequent  intervals,  as  at  the  end  of  each  period 
all  windows  should  be  opened,  preferably  while  the  children  are  for  the  time 
being  out  of  the  room,  or,  if  they  must  be  kept  in  the  room,  while  the  children  are 
exercising.  Frequent  changes  of  air  are  not  only  conducive  to  better  health  ant  > 
comfort,  but  make  for  increased  efficiency. 

Where  mechanical  methods  of  ventilation  are  depended  upon,  a “wet  am: 
dry  bulb  thermometer”  should  be  supplied  in  each  such  room,  land  the  teachers 


Minimum  Health  and  Sanitation  Standards 


11 


should  be  made  familiar  with  the  reading  of  such  thermometers  so  that  they  may 
estimate  the  relative  humidity  which  should  be  at  least  20  per  cent,  for  any  given 
temperature.  A special  chart  or  table  is  furnished  with  each  such  thermometer 
which  enables  the  teacher  after  a very  brief  experience  to  make  the  necessary 
computation.  For  the  average  room,  a tempetature  of  68  degrees  F.  is  most  desir- 
able from  the  standpoint  of  health, 
s 

Lighting 

While  proper  lighting  has  not  the  importance  of  ventilation  in  relation  to 
health,  it  is  nevertheless  of  considerable  significance  among  pupils  and  teachers 
because  it  prevents  eye  strain.  The  latter  condition  may  be  responsible  for  seri- 
ous suffering  or  discomfort  which  may  be  manifested  by  headache,  irritability, 
lack  of  attention,  fatigue,  and  be  the  cause  of  distant  or  so-called  “reflex”  dis- 
turbances which  may  be  referred  to  the  stomach  or  to  other  parts  of  the  body. 
Dr.  Ralph  E.  Wager  of  the  Department  of  Biology,  Northern  Illinois  State  Normal 
School,  in  his  study  of  the  health  of  teachers  calls  attention  to  the  marked  prev- 
alence of  defects  of  eyesight  among  them.  There  can  be  little  doubt  that  a defec- 
tive system  of  lighting  may  not  only  react  to  make  teachers  and  pupils  irritable, 
! restless  and  fatigued,  but  that  it  may  be  responsible  for  the  backwardness  of  many 
pupils.  It  is  not  sufficient  to  depend  on  visual  tests  to  discover  such  defects  of 
eyesight;  it  is  infinitely  better  to  correct  improper  lighting. 

Seating  arrangements  should  be  of  such  character  that  the  light  falls  over  the 
left  shoulder,  and  the  arrangements  of  seats  as  well  as  the  location  of  blackboards 
should  be  ordered  so  that  they  may  not  be  placed  at  an  angle  which  interferes 
! with  vision  and  produces  a glare.  It  can  be  stated  definitely  that  where  natural 
or  artificial  lighting  is  used,  the  writing  surfaces,  whether  blackboards  or  desks, 
should  be  neither  too  brilliantly  lighted  so  as  to  reflect  glares  nor  should  there  be 
marked  shadows  upon  them.  When  artificial  lights  are  employed,  care  must  be 
taken  that  they  should  not  flicker.  Those  who  are  in  the  habit  of  reading  news- 
papers or  books  in  the  subways  can  testify  to  the  blinding  effects  of  flickering 
lights,  and  they  will  readily  understand  how  this  condition  may  cause  serious  eye- 
strain. 


In  connection  with  adequate  lighting,  it  is  well  to  bear  in  mind  the  three 
requirements  which  are  always  insisted  upon  by  leading  engineers;  namely,  suf- 
ficiency, continuity  of  light,  and  diffusion.  The  sufficiency  of  light  depends  upon 
having  an  adequate  window  area.  In  order  that  there  may  be  continuity,  it  is  not 
only  necessary  to  have  a large  enough  window  area  for  use  on  comparatively 
dark  days,  but  there  must  be  provided  also  one  or  two  things — first  a way  of 
reducing  light  when  it  is  excessively  bright,  and  second,  a way  of  increasing  or 
supplementing  it  when  the  days  are  dark  as  at  the  close  of  day  in  the  winter  sea- 
son or  on  cloudy  days.  Lighting  engineers  emphasize  the  necessity  of  having 
rooms  painted  in  light  color,  especially  the  ceilings  and  the  upper  portions  of  wall 
so  that  light  will  not  be  absorbed  by  dark  surfaces,  but  be  reflected  and  diffused 
throughout  a room.  The  lower  parts  of  walls  should  be  painted  dark  to  give 
relief  to  the  eye.  The  diffusion  of  light  calls  also  for  the  proper  placing  or  dis- 
tribution of  widows. 

If  the  requirements  which  were  specified  with  reference  to  the  area  of  win- 
dow space  per  person  under  the  head  of  ventilation  are  complied  with,  the  light- 


12 


Survey  of  the  Schools  by  Teachers 


ing  requirements  will  at  the  same  time  be  well  met.  Adequate  natural  lighting 
like  natural  ventilation  is  the  best.  However,  we  must  be  careful  to  prevent  the 
glare  of  sunshine.  In  such  cases,  window  shades,  especially  those  which  can  be 
raised  from  below  upward,  are  essential.  Windows  that  have  a northern  exposure 
are  best  for  the  purpose  of  lighting.  Those  that  have  a southern  exposure  permit 
an  excessive  amount  of  sunshine  to  enter  during  the  middle  of  the  day  in  par- 
ticular, so  that  a heavy  shade  may  have  to  be  pulled  down  to  cover  the  entire  win- 
dow area,  thus  necessitating  the  use  of  artificial  lighting  during  the  early  part  of 
the  day. 

When  sunlight  enters  through  the  upper  part  of  the  window,  it  may  be  ^ 
modified  and  made  agreeable  by  having  translucent  window  glass  put  into  the  I 
upper  sash,  or  by  using  light,  translucent  shades.  The  light  entering  through! 
the  upper  part  of  the  window  diffuses  over  the  widest  area  in  the  room.  For  this  | 
reason  it  is  desirable,  to  have  windows  reach  to  as  near  the  ceiling  as  possible. 
The  opaque  or  dark  window  shade  is  undesirable.  Windows  must  be  kept  clean 
or  they  will  prevent  the  entrance  of  an  adequate  amount  of  light  even  though  the 
total  area  of  window  space  is  sufficient. 

If  the  windows  look  out  upon  a more  or  less  confined  space,  and  the  light  is 
intercepted  or  reduced  by  neighboring  buildings  much  can  be  done  to  improve  the 
fighting  of  such  rooms  by  using  what  is  known  as  prismatic  glass.  Prismatic  glass 
is  supplied  in  the  form  of  corrugated  glass,  or  has  little  prism-like  projections 
which  catch  the  light  from  any  patch  of  sky  which  such  window  may  face,  and 
reflect  or  bend  the  light,  and  direct  it  into  the  room.  While  clean  windows  are 
always  a most  important  essential  for  adequate  lighting,  they  are  of  the  greatest 
importance  where  prismatic  or  translucent  glass  is  employed,  because  in  these  the 
light  is  already  to  a certain  degree  modified. 

When  artificial  lights  are  employed,  they  must  be  properly  distributed  so  as 
to  give  light  to  all  parts  of  the  room ; they  must  be  of  adequate  candle  power,  and 
the  glare  from  such  light  which  may  fall  upon  polished  desk-tops  or  other  polished 
surfaces  must  be  eliminated  so  far  as  possible  by  the  use  of  dull  paints  and  by  the 
proper  shielding  or  shading  of  the  light.  The  lamps  that  are  supplied  must  be  kept 
clean  or  a great  deal  of  the  lighting  power  is  lost.  The  use  of  ground  glass  electric 
bulbs  or  of  ground  glass  globes  has  found  great  favor  and  is  very  desirable  be- 
cause it  prevents  glare.  Reflectors  are  extremely  valuable  in  improving  and  dis- 
tributing the  light  thrown  by  lamps,  but  they  are  utterly  useless  if  they  are  per-  - 
mitted  to  become  unclean.  It  should  also  be  remembered  that  a lamp  which  may 
give  adequate  candle  power  at  the  beginning  becomes  worn  out  with  use,  and  the 
light  therefore  grows  dimmer. 

If  artificial  light  must  be  employed  in  a class  room,  it  is  advisable  not  to  de- 
pend on  a single  light  or  a cluster  of  lights  placed  in  the  center  of  the  ceiling,  but 
if  possible  such  lights  or  clusters  should  be  distributed  about  the  walls  or  ceiling  so 
as  to  light  up  equally  well  all  parts  of  the  room.  Any  system  of  artificial  lighting 
which  permits  marked  shadows  to  be  thrown  upon  any  part  of  the  working  space 
or  particularly  upon  the  desk,  is  objectionable  and  indicates  that  an  improper 
system  is  employed.  When  artificial  lighting  is  employed  in  class  rooms,  the 
optimum  amount  of  light  for  ordinary  use  should  be  four  foot-candles.  A foot- 
candle  is  the  common  unit  of  illumination,  equal  approximately  to  one  watt,  and  is 
the  amount  of  lighting  effect  produced  upon  an  object  by  a standard  candle  held 


Minimum  Health  and  Sanitation  Standards 


13 


at  a distance  of  one  foot;  roughly,  one  can  estimate  whether  the  four  foot-candles 
which  ought  ordinarily  to  be  supplied  for  office  work  have  been  furnished,  by  the 
following  very  simple  mathematical  test:  The  candle-power  furnished  by  a lamp 
or  cluster  of  lamps  is  made  the  numerator;  the  denominator  is  the  square  of  the 
distance  of  such  lamp  or  cluster  of  lamps,  from  the  writing  surface.  For  example, 
if  a single  lamp,  or  if  a cluster  of  lamps  in  the  center  of  the  room,  gives  a light 
of  200  candle-power,  then  200  is  the  numerator ; if  the  distance  from  the  writing 
surface  of  a pupils’  desk  is  the  source  of  light  is  10  feet  then  the  square  of  the 
distance  is  100  feet,  and  the  denominator  is  therefor  100.  We  then  have  a lighting 

(power  of  200/100  which  equals  2 candle  power;  in  other  words,  we  have  only  half 
the  optimum  illumination.  The  minimum  which  should  be  allowed  for  close  appli- 
cation is  3 foot  candles ; therefore,  in  the  problem  cited,  the  boy  who  sits  10  feet 
from  a 200  foot  candle  light  is  receiving  only  one  half  of  the  optimum  or  two- 
thirds  of  the  minimum  lighting  required. 

Drinking  Water  and  Drinking  Fountains 

All  the  standards  that  have  been  previously  outlined  have  been  in  agreement 
with  those  which  are  laid  down  by  authorities  in  the  field  of  industrial  hygiene 
for  offices  and  similar  work  places.  Continuing  to  apply  such  standards,  it  ought 
to  be  emphasized  that  drinking  water  ought  to  be  readily  accessible  on  the  various 
floors  of  school  buildings  so  that  pupils  and  teachers  may  not  have  to  lose  time  in 
going  a considerable  distance  to  slake  their  thirst.  It  is  the  general  experience 
that  where  drinking  water  is  not  readily  accessible,  there  is  a tendency  to  repress 
the  desire  for  water.  The  importance  of  drinking  water  in  adequate  amount  from 
the  health  standpoint,  as  well  as  for  the  sake  of  comfort,  need  not  be  argued  at 
this  date.  Nor  need  one  dwell  upon  the  dangers  which  lurk  in  the  use  of  common 
drinking  cups. 

The  placing  of  drinking  fountains  in  sufficient  number  so  as  to  be  readily 
accessible,  is  the  best  means  of  eliminating  the  use  of  the  common  cup.  The  latter 
is  always  to  be  found  where  the  ordinary  faucet  is  used  to  control  the  flow  of  water. 
The  drinking  fountain  must,  however,  conform  to  a modern  design,  or  it  may  give 
a false  sense  of  security  with  respect  to  the  transmission  of  disease.  Such  fountain 

IKmust  deliver  a column  of  water  that  rises  to  a height  of  several  inches.  It  should 
[be  furnished  with  a metal  ring  which  prevents  bringing  the  lips  in  close  contact 
I with  the  spout  of  the  fountain.  The  column  of  water  should  not,  however,  be 
’a  vertical  one,  because  it  has  been  found  by  experience,  that  disease  germs 
which  may  be  on  the  lips  of  a person  who  uses  the  fountain,  may  remain 
supported  at  the  top  of  the  column  of  water  for  a very  considerable  period  of  time 
without  being  discharged  into  the  drain.  For  this  reason,  the  only  proper  type  of 
drinking  fountain  is  one  which  delivers  an  inclined  column  of  water  rising  to  a 
height  of  several  inches,  the  inclination  being  about  15  degrees,  so  that  any  germs 
which  may  be  caught  in  such  a column  of  water  are  not  kept  dancing  at  the  top, 
as  is  the  case  with  the  vertical  water  spout,  but  fall  over  into  the  drain  promptly. 

Sanitation  of  the  Toilet 

Toilets  should  be  readily  accessible.  A great  deal  of  unnecessary  loss  of  time 
results  when  toilets  are  housed  in  a single  unit  at  a considerable  distance  from  the 
classrooms  or  offices.  Moreover,  constipation  which  is  of  such  frequent  occur- 


14 


Survey  of  the  Schools  by  Teachers 


ence  among  pupils,  and  among  teachers  whose  life  is  a sedentary  one,  is  er( 
couraged  when  the  toilets  are  at  a considerable  distance.  This  is  the  common 
experience  with  large  groups  of  people  in  industry  and  undoubtedly  applies  to  th 
school  population. 

It  is  needless  to  say  that  the  sanitary  standards  in  the  construction  and  equif 
ment  of  toilets  should  conform  to  those  laid  down  for  industry,  that  is,  there  shoul 
be  a sufficient  number  of  toilets  for  the  school  population;  they  should  be  so  cor 
structed  that  the  ventilation,  lighting  and  heating  conform  to  the  standards  alread 
laid  down ; they  should  insure  privacy,  for  it  has  generally  been  found  that  whei 
there  is  no  privacy,  there  is  a tendency  towards  demoralization  through  the  for<  ■ 
of  bad  example  and  through  the  operation  of  “crowd”  psychology.  The  m;m 
terial  entering  into  the  construction  of  the  toilets  should  be  impervious,  an 
non-corrosive,  and  the  construction  should  allow  for  proper  drainage  so  that  thei 
may  be  no  stagnation  or  accumulation  and  exposure  of  excrement.  The  windov 
and  doors  of  the  toilets  should  be  particularly  shielded  during  the  spring  an 
summer  time  by  the  use  of  screens  to  prevent  the  entrance  of  flies. 

It  should  be  remembered  that  while  one  hundred  and  eleven  typhoid  carriers  ai 
known  in  the  City  of  New  York,  it  has  been  estimated  that  from  1 to  5 per  cent.  ( 
those  who  have  had  typhoid  fever  remain  typhoid  carriers,  discharging  typho 
bacilli  in  their  excrement  for  many  years  or  for  the  rest  of  their  lives.  In  ti 
City  of  New  York,  we  have  had  over  twenty  thousand  recognized  cases  of  typho 
fever  which  were  reported  to  the  Department  of  Health  in  the  last  ten  year 
It  will  be  seen  at  a glance  that  there  must  be  many  more  typhoid  carriers,  eve 
if  we  limit  ourselves  to  the  cases  which  occurred  in  the  last  ten  years,  than  a 
known  to  the  Health  Department.  This  may  include  many  school  teachers  « 
pupils  who  recover  or  who  may  be  healthy  carriers.  The  entrance  of  flies  whi< 
have  access  to  excrement  that  is  not  promptly  and  effectively  washed  away  < 
drained,  is  therefore  a possible  source  of  danger.  The  trough  urinal  or  receptac 
in  toilets,  or  the  so-called  school  sinks  are  a source  of  danger.  Water-flush* 
and  properly  sewer-connected  drainage  for  all  toilet  fixtures,  together  wii 
screens  at  windows  and  doors,  are  very  essential  to  prevent  the  possible  spread  < 
typhoid  fever,  and  of  other  intestinal  diseases  through  the  medium  of  flies. 

Washing  Facilities  in  Toilets 

The  washing  facilities  in  toilets  should  be  adequate.  Typhoid  carriers  a 
safe  to  others  only  to  the  degree  in  which  they  exercise  care  promptly  and  the 
oughly  to  wash  their  hands.  Therefore,  washing  facilities  should  be  available 
toilets  or  near  toilets,  and  also  in  other  parts  of  the  building  so  as  to  be  read 
accessible.  A variety  of  communicable  diseases  are  no  doubt  transmitted  as  t 
result  of  infection  of  the  hands  through  contact  with  the  nose  and  mouth,  as  w< 
as  through  possible  soiling  with  human  excrement. 

The  supply  of  washing  facilities,  and  the  installation  of  hot  water  regulat 
so  as  to  be  of  proper  temperature,  is  extremely  important  from  the  standpoint 
health  to  the  individual  pupil  or  teacher,  and  to  those  with  whom  they  may  coi 
in  contact.  The  supply  of  soap  and  towels  in  suitable  quantity  is  also  extrem* 
important.  Measures  have  been  devised  which  permit  one  to  provide  these  up 
an  economical  and  practical  basis.  Special  paper  towels,  as  well  as  propet 


Minimum  Health  and  Sanitation  Standards 


15 


secured  cloth  towels,  are  available  on  the  market.  It  is  more  economical  to  prevent 
disease  by  supplying  proper  washing  facilities  as  well  as  to  inculcate  proper  per- 
sonal habits  in  pupils,  than  it  is  to  save  money  by  omitting  such  facilities  and 
ixtures. 

General  Cleanliness 

Reference  has  already  been  made  to  the  economy  which  results  from  keeping 
vindows  and  lighting  fixtures  clean.  The  general  cleanliness  of  floors  and  all 
iurniture  hardly  needs  to  be  alluded  to  in  the  light  of  modern  knowledge.  It  is 
mportant  that  dry  dusting  and  dry  sweeping  be  eliminated  from  all  schools,  no 
matter  at  what  hour  performed,  but  especially  before  the  opening  of  school  or  at 
iny  time  during  the  school  day.  Dry  dusting  and  sweeping  tends  only  to  scatter 
lust,  and  is  not  effective  for  its  collection  and  disposal.  Mopping  of  the  floors 
vith  oil  cloths  or  with  damp  cloths  or  so-called  “settlers/ ” like  oil  particles  or  wet 
sawdust,  is  essential,  and  this  should  be  done  when  the  school  has  been  completely 
emptied  of  pupils  and  teachers.  In  this  connection,  reference  should  be  made  to 
he  chalk  dust  which  is  set  free  in  class  rooms  or  which  results  from  the  cleaning 
)f  erasers.  This  should  be  prevented  so  far  as  possible  by  the  use  of  moist  cloths 
or  erasing  chalk  marks.  While  this  may  involve  loss  of  time,  it  is,  however, 
)rofitable  in  the  long  run.  Pupils  should  never  be  asked  to  clean  blackboard  erasers! 

Rest  Room  and  Lunch  Room 

In  modern  industry,  it  has  been  found  not  only  desirable  but  necessary  and 
‘conomical,  to  provide  a lunch  room  where  those  who  are  unable  for  a variety  of 
•easons  to  secure  luncheon  at  their  homes  or  in  restaurants,  may  find  suitable  and 
>anitary  quarters  to  be  used  as  lunch  rooms.  WLile  this  is  not  so  important  in 
:he  school  as  it  is  in  certain  branches  of  industry,  nevertheless,  in  the  interest  of 
?ood  housekeeping  and  comfort,  it  is  desirable  so  far  as  possible  to  have  places 
which  are  available  for  use  as  lunch  rooms  for  pupils  and  teachers.  While  a 
properly  fitted  up  lunch  room  which  has  come  to  be  recognized  as  an  essential  in 
velfare  work  for  those  employed  in  industry,  may  be  difficult  to  obtain  in  the 
schools,  there  can  be  no  question  whatever  that  a rest  room  suitably  fitted  up  to 
>ermit  pupils  and  teachers,  who  may  be  temporarily  indisposed  or  ill,  to  rest,  is 
lecessary  as  well  as  desirable.  Many  absences  which  formerly  occurred  in  in- 
lustry  because  adequate  facilities  for  rest  or  for  emergency  medical  and  nursing 
•elief  were  lacking,  have  now  been  eliminated  in  industrial  establishments  which 
lave  regard  for  the  health  of  employees.  This  has  been  done  by  the  installation 
)f  rest  rooms  where  nursing  care  or  quiet  can  be  obtained  and  where  indispositions 
ire  promptly  ministered  to  with  the  least  degree  of  suffering  to  those  so  affected 
ind  with  the  ultimate  prevention  of  more  serious  developments.  To  use  the  ver- 
nacular, rest  rooms  have  been  found  to  be  a “paying  proposition/’ 

Unfortunately,  it  is  not  possible  in  the  brief  compass  of  an  address  of  this 
character,  to  dwell  upon  the  necessity  for  maintaining  proper  health  in  pupils  and 
eachers  by  the  observation  of  rules  of  personal  hygiene  which  are  extremely  im- 
portant, and  which,  if  violated,  tend  to  weaken  resistance  or  favor  the  development 
>f  disease.  Much  could  be  said  about  the  value  of  an  adequate  and  proper  diet, 
aulty  habits  of  eating,  as  well  as  the  use  and  abuse  of  exercise,  the  need  for  rest 
periods,  the  value  of  adequate  sleep,  the  avoidance  of  exposure  to  excessive  heat  and 

I- 


16 


Survey  of  the  Schools  by  Teachers 


cold  at  various  seasons  of  the  year,  and  the  relation  of  proper  methods  of  dre 
to  such  conditions.  Attention  to  these  details  is  required  in  the  school,  as  w 
outside  of  the  school.  The  health  aspects  of  recreation  and  many  other  t 
which  are  directly  related  to  personal  health,  might  be  profitably  dwelt  upon 
this  address  was  not  intended  to  emphasize  these  things. 

By  way  of  conclusion,  it  is  desirable  to  refer  again  to  the  necessity  for 
quate  medical  supervision  and  study  of  teachers,  with  a view  to  ascertaining 
physical  condition  and  fitness  at  the  time  of  their  entrance  into  the  profession, 
the  casualties,  and  damages  to  health  which  may  be  recorded  at  various  s 
of  their  career  in  the  profession,  with  a view  to  determining  more  accurately 
has  been  done  in  the  admittedly  limited  studies  which  have  been  made  hereto 
There  can  be  no  doubt  of  the  scientific  value  of  studies  which  concern  thems 
not  only  with  the  results  of  medical  examinations  made  at  the  time  of  ent 
into  the  profession  and  periodically  repeated  examinations  thereafter,  but  also 
careful  sickness  reports  and  follow-up,  and  medical  examinations  to  recor 
character,  duration  and  the  ultimate  effects  of  all  illnesses  whether  deemed  triv: 
important,  conducted  over  a considerable  period  of  time.  In  this  way  alone, 
be  possible  to  obtain  knowledge  of  scientific  value  and  importance  in  safegua^ 
the  health  of  teachers,  and  protecting  pupils  from  the  physical  and  mental  e 
of  sickness,  to  which  teachers  may  be  subject. 


BIBLIOGRAPHY 

Physical  Disability  of  New  York  City  School  Teachers — Louis  I.  Dublin,  Ph.D 

Ad-interim  Report  of  an  Investigation  of  the  Absences  of  New  York  School  Tea 
During  the  School  Year  1913-1914 — Dr.  Oswald  Schlockow. 

Health  of  the  School  Teacher — Dr.  Ralph  E.  Wager  (published  in  the  Journ 
Industrial  Hygiene,  September,  1920). 

Report  of  Commission  on  Welfare  of  Teachers — T.  D.  Wood,  New  York  State  Tea 
Association,  1916. 

The  Teacher’s  Health — L.  Terman. 

Diseases  of  Occupation  and  Vocational  Hygiene — Kober  & Hanson. 

Classroom  Ventilation  and  Respiratory  Diseases  Among  School  Children — S.  Jose 
Baker,  M.D.,  Department  of  Health,  New  York. 

Report  of  Divisional  Committee  “Code  of  Lighting”  of  the  Committee  on 
Advisory  Commission,  Council  of  National  Defense — Bulletin  No.  3 of  W 
Work  Series,  Government  Printing  Office. 

Report  of  the  Divisional  Committee  on  Heating  and  Ventilation  of  the  Commit 
Labor,  Advisory  Council  of  National  Defense — Bulletin  No.  4 of  Welfare 
Series,  Government  Printing  Office. 

Tentative  Syllabus  on  Hygiene  for  Elementary  Schools — Approved  by  the  Boa 
Superintendents,  Department  of  Education,  New  York,  September,  1916. 


